prescribe and sell the pharmaceutical products necessary to treat a diagnosed condition. What is unethical or a con- flict of interest is for a veterinarian to sell ...
VETERINARY MEDICAL ETHICS I
I
DEONTOLOGIE VETERINAIRE
Ethical question of the month - September 1996 Question de deontologie du mois - septembre 1996 Is it a conflict of interest for a veterinarian to S'agit-il d'un conflit d'interet lorsqu'un medeprescribe and sell pharmaceutical products? cin veterinaire prescrit et vend des produits
pharmaceutiques?
Comments No! It is an inherent necessity for the practitioner to prescribe and sell the pharmaceutical products necessary to treat a diagnosed condition. What is unethical or a conflict of interest is for a veterinarian to sell pharmaceuticals without prescribing, that is, making a specific diagnosis. Also, it is unethical to knowingly sell pharmaceuticals for resale. An acceptable universal mark-up on pricing would remove competition by Vfterinarians for pharmaceutical sales. This would ret n the emphasis to professional services as the major function of the veterinary practitioner.
H.J. Humney, DVM, Midland, Ontario
An ethicist's commentary on the case of whether a veterinarian prescribing and selling drugs is in a conflict of interest situation As stated, the question is ambiguous and can have 2 distinct meanings. It can be interpreted in a weak way to mean "Can there ever be a conflict of interest occasioned by a veterinary practitioner prescribing and selling pharmaceuticals?" Alternatively, it can be taken in a much stronger way to mean "Must there always be a conflict of interest occasioned by a veterinary practitioner prescribing and selling pharmaceuticals?" The answer to the first interpretation is certainly affirmative. There are surely situations where a conflict of interest could arise. For example, a veterinarian could have a financial interest in a particular pharmaceutical, say a vaccine that competes with other vaccines on the market. Were the veterinarian to exclusively prescribe or sell that particular vaccine on a routine basis, without explaining his or her proprietary interest, and without explaining to clients that there are other vaccines on the market and why this one is the best, the veterinarian would certainly be generating such a conflict. Similarly, if the veterinarian prescribes or dispenses an antibiotic by trade name solely because there is a higher profit to be made on it than on the identical generic product, and fails to inform the client that one can Can Vet J Volume 37, December 1996
buy the generic easily and cheaply at a large, competitive pharmacy, the veterinarian is again in a conflict of interest situation. The conflict, of course, arising between his or her role as a medical professional and his or her role as profit-making merchant. In short, a conflict of interest can certainly arise between the veterinarian's obligation to do the best for the client (a professional obligation) and desire to maximize income, if the veterinarian fails to notify the client of different and cheaper alternatives to the prescribed regimen that benefits him or her the most economically. When one turns to the second interpretation, however, one can readily see that it is not necessarily the case that a conflict of interest must arise just because the veterinarian prescribes or sells drugs. If the veterinarian is honest, straightforward, and open with the client, conflict of interest can be avoided. For example, suppose the veterinarian is prescribing the aforementioned antibiotic, generic or not, it is very unlikely that he or she can compete with a high volume pharmacy. On the other hand, it is perfectly fair that the veterinarian be compensated for the convenience afforded to the client by not having to go to the store, or for the money the veterinarian has locked into inventory, etc. In a small, rural community, with no pharmacy nearby, both the convenience for the client and the requisite inventory can be considerable. As always, the proper source of action is "a mean between extremes," in Aristotle's felicitous phrase. One ought not expect a veterinarian to provide the service of supplying drugs for no recompense. On the other hand, outrageously marking up those drugs for trusting clients is not only morally questionable, it is highly imprudent. For once you have earned a reputation for gouging clients in one area, it is difficult to mitigate that reputation. Even in the medical arena, your recommendations will be suspected if you are perceived as markedly enhancing your own income at the expense of the client. Though I have heard it argued that some veterinarians keep their fees down by overcharging on medicine, I do not accept that argument. It is better to practice and to charge top dollar for first-rate medicine that provides excellent service to clients than to attempt 713
to compete by quietly charging too much for pharma- overcharging on drugs is petty and very likely to lead to ceuticals. If you do the former, the worst that clients can people wondering whether you overcharge on everything, say is that "he (she) is really good and charges for it." even if you don't. Surveys have shown that cost is not a main factor for most clients, if the service is superb. On the other hand, Bernard E. Rollin, PhD
Ethical question of the month - December 1996 Question de deontologie du mois - decembre 1996 Responses to the case presented are welcome. Please limit your reply to approximately 50 words and mail along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, Health Management, Ontario Ministry of Agriculture, Food and Rural Affairs, Wellington Place, RR#1, Fergus, Ontario NlM 2W3; telephone: (519) 846-0965; fax: (519) 846-8101. Suggested ethical questions of the month also welcome! Les reponses au cas presente sont les bienvenues. Priere de limiter votre reponse 'a environ 50 mots et de nous la faire parvenir par la poste avec votre nom et adresse a l'adresse suivante: Choix deontologiques, a.s. docteur Tim Blackwell, Groupe de la sante des animaux, ministere de l'Agriculture, de l'Alimentation et des Affaires rurales de l'Ontario, RR#1, Fergus (Ontario) NlM 2W3; telephone: (519) 846-0965; tel& copieur: (519) 846-8101. Les soumissions de questions deontologiques sont toujours bienvenues!
You are the staff veterinarian at a research facility at a university medical school. An animal health technician presents you with a rat that has a badly infected hindlimb following surgery. The research project involved has received full approval from the university Animal Care Committee. You know, both from the research protocol and from previous experience with the project, that long-term survival of the rat is critical to the success of the research. The principal investigator has always been very cooperative; however, he is out of the country for 2 weeks and cannot be contacted. His research associates suggest that you take no action until the principal investigator returns. Provision for treatment is not included in the experimental protocol and a minimum number of rats have been assigned to the trial, so the loss of 1 rat could affect the significance of the results. You feel that this rat should receive immediate treatment or be euthanized. What action should you take?
(Submitted by Dr. Kathleen Delaney, Hamilton, Ontario)
Vous etes le medecin veterinaire en titre d'une installation de recherche d'une ecole de medecine. Un technicien en sante animale vous presente un rat qui, a la suite d'une chirurgie, a une infection serieuse a une patte posterieure. Le projet de recherche a ete approuve par le comite de l'universite sur le bien-etre des animaux. En raison du protocole de recherche et de votre experience avec le projet, vous savez que la survie a long terme du rat est essentielle au succes de la recherche. Le chercheur principal a toujours coopere; toutefois, il est hors du pays pour 2 semaines et il est impossible de communiquer avec lui. Ses assistants de recherche vous suggerent de ne rien faire jusqu'a ce que le chercheur soit de retour, car le protocole de recherche ne contient aucune disposition quant au traitement, et un nombre minimal de rats est assigne a ce projet; la mort d'un seul rat pourrait donc miner l'importance des resultats. Vous etes d'avis que ce rat devrait etre soigne immediatement ou euthanasie. Que devriez-vous faire? (Soumis par docteure Kathleen Delaney,
Hamilton [Ontario]) Comments/Commentaires:
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